Nurse to Patient Ratios (Term Paper Sample)

Chapter 1 THE PROBLEM AND ITS BACKGROUND Introduction Nursing is a practice that has long been present and has come to become one of the most indispensable professions in the field of medicine and healthcare. Nursing requires dedication passion and the drive to help others in need. With these characteristics, one can fulfill the commonly practiced nursing duties such as round-the-clock care and attention to patients to be able to meet the prerequisites of providing proper care. Due to the nature of this profession, the shift hours are sometimes inevitably extended to accommodate heavy workloads and patient needs. As a general circumstance, every patient is unique, and their needs differ from the needs of other patients. Providing interventive treatments ordered by physicians and ensuring that proper procedure is done even without the presence of doctors is one of the main duties of nurses. They prevent the deterioration of the conditions of the patients they care for and if necessary, assess if the patient needs higher levels of care. Providing sufficient and effective care is reliant on many factors. Nurses are trained to handle a multitude of situations that differ from one another to prepare them for practicing nursing in real life. Providing care for patients requires flexibility in time, skill, patience, and even physical capability. Many nurses in the Philippines are reported to be overworked due to the demand for patient care in many large hospitals with limited funding and resources to employ enough nurses for a desirable nurse-patient ratio. The nurse-patient ratio shows the number of nurses assigned to a certain number of patients. Commonly, it is measured as the number of nurses assigned to the number of beds they oversee in a hospital. The nurse-patient ratio is an estimator of the workload of the nurses which then affects their performances and increases the odds of patient survival, among other things such as qualifications, skill, and job satisfaction (Lee et al., 2017; Kousar et al., 2018). In the Philippines, to maintain a quality of service and care provided by the nurses, the government has stipulated in Section 34 of The Philippine Nursing Act of 2002 (RA 9173) that “The government and private hospitals are hereby mandated to maintain the standard nurse-patient ratio set by the Department of Health.” From this, the DOH through Administrative Order 2012-0012 has set that the ideal nurse-to-patient ratio is 1:12 (DOH, 2012), but this is hardly true in many hospitals. The effects of low nurse-patient ratios are interconnected with the shortage of nurses and its subsequent effects. These situations form an endless cycle that only worsens the existing issues of nurse staffing. According to Robert Mendoza, president of The Alliance of Health Workers (AHW) said lack of human resources affects the delivery of quality health care to patients. Due to overworking and low pay, there is a reported low percentage of nurse retention in the Philippines where nurses are choosing to work abroad due to better options and benefits. Hapal’s article (2017) involved a statement from a Filipino nurse stating that in the Philippines, the common nurse-patient ratio is 1:40, which is a problematic situation in terms of the quality of care that can possibly be provided. In order to end this cycle, the only solution is to improve the nurse-patient ratios in every hospital. Worldwide, nursing shortages are being observed for a myriad of reasons. Despite these situations, the demand for more nurses has never been higher due to the increasing number of patients yearly. According to the American Association of Colleges of Nursing (as cited by Kavilanz, 2018), many colleges have turned down qualified nursing applicants due to an insufficiency of classrooms, teachers, materials, equipment, facilities, and general resources to accommodate all applicants. A shortage of nurses in hospitals or healthcare institutions is one of the major factors contributing to undesirable nurse-to-patient ratios. Due to understaffing, many hospitals are forced to assign more patients to nurses causing declines in performance and satisfaction. In addition, drastic shifts in patient acuity can also affect the occurrence of missed care because patients with greater needs tend to take more of the nurses’ time. As a result, adequate patient care is usually compromised. In the Philippines, nurses tend to prefer working in an environment that gives the best benefits and work opportunities. However, in most cases, those requisites cannot be found in the Philippines for there are many limitations especially financially. Because of this circumstance, Philippine-trained experienced nurses have no choice but to seek employment abroad either temporarily or permanently. In certain cases, patients here are left in the care of inexperienced nurses making it unfavorable to both parties since the number of nurses staying in the Philippines also decreases as well. Missed care can be attributed to many factors such as poor nurse performance, unavailability of equipment and facilities, poor caregiver or staff communication, and even insufficient record management. Missed care is commonly committed when nurses are spread too thin with their heavy workload, or the number of patients and duties assigned to them are increased. Nurses have set duties to perform daily and their routines are planned for them to maximize their time and still provide a good quality of care to the patients. Missed nursing care is any action of patient care that has not been performed in part or in whole that has been neglected to be performed (Kalisch, Landstrom, and Hindshaw, 2009). Missed care is often not discussed because of the mere fact that the care procedures included in the said concept are considered minor parts of nursing duties. However, omission or incomplete performance of these activities may affect the patient directly or indirectly. A nurse’s workload contributes greatly to the occurrence of missed care. This is where nurse-patient ratios come into play in determining the reason behind missed care. In hospital management, oversights involving scheduling and nurse staffing have been happening frequently due to a lack of options caused by the insufficient number of nurses being hired by hospitals. It is an unfortunate occurrence that nurses nowadays are forced to do the bare minimum care to patients and for that action to be considered acceptable due to the absence of other nurses that can be put in charge of other patients which will lighten the workload for each nurse. However, it is also a burden on the nurses’ emotional aspect that they cannot give the proper care to all those patients in their respective areas. Since a certain nurse, for example, attends a department with more than fifteen patients all by himself/herself, then the result will be missed care to the patients and physical and psychological stress on the nurse. According to Haddad and Toney-Butler (2019), in hospitals with low nurse-to-patient ratios where there are many patients assigned to one nurse, nurses are exposed to risks of burnout, and job dissatisfaction, and have higher incidences of missed care compared to those hospitals or institutions with higher nurse-patient ratios. One of the factors resulting in missed care is that applicable laws that should have been implemented by government bodies are either neglected or disregarded due to the fact that hospitals or medical establishments also need to consider the financial aspect of the situation. In recent years, it has been observed that the nursing profession continually evolves in such a way that we are now dealing with technological advancements, such as equipment and medical platforms among others. In this new era, the medical field is flooded by new technology, paving the way for a more sophisticated or easier means of nursing a patient. These new devices or facilities decrease nursing workload and help nurses manage and maximize their time to provide optimal care to the patients. In addition, outsourcing has been steadily gaining popularity in healthcare and many healthcare institutions and hospitals outsource some of their processes to be able to accommodate patients in need of nurses who are present physically. According to Tucker (n.d.), in the US, hospitals have services that can be conducted over the phone or online such as patient record-keeping and assessment. These are new ways of giving patient care called Business Process Outsourcing, which clears or decreases nurse responsibilities and duties that can be dealt with without being physically present and thus can be outsourced to other companies providing the service. By decreasing their bedside duties, nurses will have more time to increase their performance or take charge of more patients without risks of overworking or missed care. However, it is still understandable that humans performing bedside care are still the best and most popular way of giving quality and safe care to patients, given full consideration specifically when an adequate or enough number of personnel are deployed to perform such duties. In view of the facts and circumstances, the researcher has endeavored to start this study aiming to further contribute to increasing knowledge about the impacts of poor nurse-patient ratios on quality of care and reasons behind the incidences of missed care. Statement of the Problem This study aims to determine if there is a relationship between the prevalence of missed patient care and the occurrences of low NTP ratios. This study will use the data collected from respondents working in the hospitals to predict the quality of care they provide in relation to nurse-patient ratios. Specifically, this study aims to answer the questions: 1.What is the profile of the respondents in terms of: 1.1age; 1.2sex; 1.3civil status; 1.4Highest nursing studies attain...